From the Guidelines
The patient's imaging shows a 4.6 mm stone in the proximal left ureter, causing mild hydronephrosis and hydroureter, along with additional small bilateral kidney stones, and our plan is to closely monitor the stone's position and assess for any changes in hydronephrosis. We will manage the patient's condition with pain medication and increased fluid intake to help pass the stone naturally, but if the pain becomes severe or the patient develops fever, we may need to consider a urological procedure, such as ureteroscopy (URS) or shock wave lithotripsy (SWL), to remove the stone, as URS has been shown to have high stone-free rates, especially for proximal ureteral stones, with a stone-free rate of 81% 1.
From the Research
Results and Plan
- The patient has a 4.6 mm stone present in the proximal left ureter with mild proximal hydronephrosis and hydroureter, as well as additional small bilateral kidney stones, as indicated by the imaging results 2.
- The patient should be informed that the presence of a ureteral stone with concomitant hydronephrosis increases the risk for acute kidney injury, and that urolithiasis remains a risk factor for acute kidney injury even without hydronephrosis 3, and that the treatment plan will be designed to promote and protect the patient's wellbeing, taking into account their individual goals and wishes, as well as objective criteria for wellbeing 4.